Medicaid Incentives for Prevention of Chronic Diseases Evaluation (CMS-10477)

ICR 201410-0938-001

OMB: 0938-1219

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Supporting Statement B
2014-10-01
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-07
Supplementary Document
2013-08-06
Supplementary Document
2013-08-06
Supporting Statement A
2014-10-01
ICR Details
0938-1219 201410-0938-001
Historical Active 201308-0938-006
HHS/CMS 20261
Medicaid Incentives for Prevention of Chronic Diseases Evaluation (CMS-10477)
Revision of a currently approved collection   No
Regular
Approved without change 10/29/2014
Retrieve Notice of Action (NOA) 10/01/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 01/31/2017
4,706 0 4,686
2,236 0 1,836
0 0 0

Section 4108 (a) (1) of the 2010 Affordable Care Act (ACA) established the Medicaid Incentive for Prevention of Chronic Disease program (MIPCD). This national demonstration awarded 10 grants to states to implement programs that provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. Programs address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition. Programs are comprehensive, widely available, easily accessible, and based on relevant evidence-based research and resources. Under Section 4108 (d) of the Affordable Care Act, Health and Human Services Secretary through the Centers for Medicare and Medicaid Services (CMS) awarded a contract to Research Triangle Institute to conduct an independent assessment of these 10 State demonstration Grantees. This assessment will focus on evaluating:(A)the effect of the initiatives on the use of health care services by Medicaid beneficiaries participating in the program;(B)the extent to which special populations (adults with disabilities, adults with chronic illnesses, and children with special health care needs) are able to participate in the program; (C)the level of satisfaction of Medicaid beneficiaries with respect to the accessibility and quality of health care services provided through the program; and(D)the administrative costs incurred by State agencies that are responsible for administration of the program. To address these topics we will be conducting Site Visits, Stakeholder Interviews, Focus Groups, Beneficiary Survey and Administrative Cost Forms.

PL: Pub.L. 111 - 148 4108 Name of Law: Affordable Care Act
  
PL: Pub.L. 111 - 148 4108 Name of Law: Affordable Care Act

Not associated with rulemaking

  79 FR 42018 07/18/2014
79 FR 57932 09/26/2014
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,706 4,686 0 20 0 0
Annual Time Burden (Hours) 2,236 1,836 0 400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The addition of the two Administrative Costs Forms adds two new collection instruments to this package. These forms increase the burden to include 20 more respondents; 400 more total burden hours. The new total burden associated with this information collection is 2,236 hours.

$155,126
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Denise King 410 786-1013 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/01/2014


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